COVID Risk Up to 50% Higher for Nursing Home Residents Behind on Vaccination

Nursing home residents who were not up to date with their COVID-19 vaccines had a 30% to 50% higher risk of getting infected compared with those who were up to date, CDC researchers said.

From Oct. 10, 2022 to Jan. 8, 2023, weekly COVID incidence rates ranged from 7.2 to 15.6 per 1,000 nursing home residents among those who were up to date with vaccinations compared with rates of 9.5 to 18.8 per 1,000 among those who were not up to date (incidence rate ratios 1.3-1.5), reported Heather Dubendris, MSPH, of the National Center for Emerging and Zoonotic Infectious Diseases, and colleagues.

“It is critical that nursing home residents stay up to date with COVID-19 vaccines and receive a bivalent booster dose to maximize protection against COVID-19,” they wrote in the Morbidity and Mortality Weekly Report.

“Although bivalent booster doses were recommended during fall 2022, and the time to receive the bivalent booster dose and remain up to date according to current recommendations has been limited, the proportion of nursing home residents in this study who were up to date (48.9%) was lower than the percentage of nursing home residents who completed a primary series (86.1%) and who received monovalent booster doses (87.0%),” Dubendris and team noted.

Reasons for missed bivalent boosters among nursing home residents included “the perception that additional vaccination is unnecessary because of beliefs of low booster vaccine effectiveness, misinformation about the severity of illness, or vaccination fatigue related to changes in guidance and recommendations for more doses,” they added. “Access to vaccination at the facility might also have an impact.”

Residents with up-to-date COVID vaccination status increased from 37.5% to 48.9% during the study period, beginning the week of October 23, with similar increases across all facility sizes and geographic regions.

“Efforts to address barriers and increase bivalent COVID-19 booster dose coverage among nursing home residents are critical to preventing illness, severe disease, and death in this population,” Dubendris and colleagues wrote.

Recent studies have shown that bivalent boosters produced a robust immunologic response in nursing home residents, and provided additional protection against severe outcomes from COVID, compared with monovalent vaccination alone.

For this study, Dubendris and colleagues evaluated data from 16,352 CMS-certified nursing homes, 92% of which reported case and vaccination data for at least one week during the 13-week study period from Oct. 10, 2022 to Jan. 8, 2023.

An average of 14,791 facilities reported both vaccination and case data each week. Facilities ranged in size, with a median of 116 healthcare personnel per facility.

Dubendris and team noted that misclassification of case and vaccination status was possible, particularly with the changing guidance on what constitutes being up to date.